A Unique Exposure of the Profunda Femoral Artery to Repair a Popliteal Artery Aneurysm

BACKGROUND:
The profunda femoral artery is a well known inflow source for lower extremity revascularization. It is utilized in patients who have extensive scarring or localized infection of the groin or in patients with limited autogenous conduit. The anterio-lateral, anterio-medial, and posterio-medial approaches to the profunda femoral artery are well described in the literature. A true posterior approach to the medial and distal profunda, however, has only been described in a single case report over four decades ago. We describe a posterior approach to the profunda femoral artery for revascularization of a patient with a large popliteal artery aneurysm and limited autogenous conduit.
METHODS:
A 79 year old male presented with a symptomatic 4.8cm popliteal artery aneurysm. A short segment of basilic vein was the only vein available for use as an autogenous conduit. His aneurysm exhibited enlargement on serial duplex scans despite a long segment occlusion of the superficial femoral artery. CT angiography revealed a well collateralized profunda femoral artery with a large caliber terminal segment. A posterior approach to repair the popliteal aneurysm was selected to provide optimal exposure for endoaneurysmectomy and ligation of collaterals to the aneurysm sac. The terminal segment of the profunda femoral artery was exposed through this incision and was used as inflow for a profunda to below knee popliteal bypass using the short length of basilic vein. The patient did well and was discharged home post-operative day 2. He has done well, ambulating without difficulty and with normal post-op noninvasive vascular studies. Here we describe the technique and the indications for exposing the distal profunda femoral artery via a direct posterior approach.
CONCLUSIONS:
Although multiple approaches to the profunda femoral artery have been described for use as inflow for lower extremity revascularization, the profunda femoral artery has not been previously used as an inflow vessel when using a posterior approach to the popliteal artery. This approach offers an alternative inflow site for patients with limited autogenous conduit and long segment superficial femoral artery disease.